Hypochondriasis in the age of COVID-19

A cough, a sneeze, feel a chill, an uncomfortable response to pollen : "Oh dear, I got it, I’m going to die on a respirator. All alone, that damn virus got me." This all happens in a moment and passes just as quickly. But in that moment there is a basic truth which every psychotherapist explores. What is the nature of our experience and from whence does it come?

I was asked recently on the ISEPP Listserve (from which I usually keep my distance), "What do you do in psychotherapy that warrants payment from the patient? " A perfectly reasonable question, why did it irritate me so much?

A digression that I hope will help answer the inquiry: Several years ago Tomi Gomory (one of the "3 amigos" of Kirk, Cohen and Gomory, authors of Mad Science, Psychiatric Coercion, Diagnosis, and Drugs) in a presentation at an ISEPP conference proclaimed that psychotherapy was nothing more than an educational process. The ignorant-patient-client is educated by the knowlegable-teacher-psychoanalyst. Hold that for a bit.

A prominent complaint of many ISEPP members is that they loathe the medical model. A brief definition: the person, the prospective patient perceives that there is something wrong (i.e., he has a symptom). He consults with a physician and presents his symptom. The physician explores the history of the symptom, does a physical examination, makes a diagnosis, and prescribes: a drug, ECT, exercise, dietary and life style modification, etc., or in the world of "mental illness" psychotherapy, psychoanalysis, cognitive behavioral therapy, family therapy, group therapy—you get the idea.

The Listserve crowd just doesn’t like this medical model. And the DSM language and jargon used by practitioners can create despair about earning a living using such a model. I understand this despair and indeed partake of it periodically myself, the despair that is. My better angels, however, allow me to avoid the traditional trap of the medical (educational) model. Remember, psychoanalysis is based on the medical model. So follow me:

Routinely, I tell this new person in my office (or on the phone or video in this era of "social distancing" to "flatten the curve" of the corona menace): "You are troubled, yes, you are struggling and in pain but you do not have a disease." I may offer an interpersonal "diagnosis" at this point such as "You are in grief" or "You have problems with intimacy" or "You are furious at your father with murderous rage that paralyzes you because you also love him." I then tell them I am interested in their struggle or not. If not I refer them on to get help else where, a lawyer or neurologist or financial advisor, or a psychopharmacologist if they are believers in better-living-through-chemistry, and I believe I could work with them. We might need another session or two to make up our minds. The next is crucial, and it is counter to the usual "educational" model.

Psychotherapy: Who is teaching Whom?

I tell the patient THEY ARE THE TEACHER and I am the student. For example, "I’m a woman, what do you know about women?" One might ask. I reply, "Exactly! You will have to teach me, what the hell does a man know about being a woman!" And it is up to them to educate me by addressing the question, "Who are you and what are you doing here?" Unfortunately many take this question so literally they miss the existential point so some explanation might be needed.

A "technical" example of the implication of this approach: When a patient tells me a dream for the first time, I give a little speech, "I don’t think it proper to tell another person what their dream means, to interpret their dream." In fact I think it disrespectful. However, I will tell them what their dream means to me if I had that dream. I adopt the dream. "If that had been my dream last night, that desolate landscape would be a reflection of how I wish to get rid of all the troubling people in my life because I feel so inadequate in having to please all of them." "No Doc, that’s not what it means to me, I’ve been freaked out how all the streets are empty because of this fucking virus." Okay.

Harry Stack Sullivan coined the term "participant observation" as the function of the psychotherapist. The therapist is the participating-expert-student of the patient- teacher. The "psychotherapy" takes place within that relationship.

Back to the stressful COVID19 pandemic times. There is now massive hypochondriasis. The hypochondriac is forever frightened that he is sick. Actually he knows there is something wrong and obsesses in his effort to interpret his symptoms and sensations. In the case of the pandemic, however, it is not just "I am sick." But rather "We are sick, our leaders are sick, our physicians are sick. Our society is sick. The world is sick, etc." Whereas the individual misinterprets some felt sensation, e.g., a cough, and obsesses about it, the pandemic unleashes pervasive misgivings about the meaning(s) of life and our relationship to the universe.

My true feeling at this time is depression. Depression for me means I am working on something deep within me. Who am I and who are we? How do I survive? Why do I survive? Randomness? Determined? Must I make up the meaning or must I discover it? Both?

3 Comments

Dear Steve,
Thanks for the feedback.
I do not work from a medical model! I make clear that the patient/client does not have a disease.
I work from an existential model in which the therapist learns from the patient and supports his/her exploration of who they are. What they do with the therapy/insights is up to them.
sincerely,
jt

I respectfully disagree with your “medical model.” I contend that medical science creates confusion by allowing psychiatry to be an anomaly among medical sciences: it addresses a philosophy (of “mind”) rather than a natural science (biology and physiology). Medical schools have a long tradition of accepting psychiatry’s philosophy of “mind” as medical “science” including a wide array of philosophies about “madness” as “medical models.” But the public generally reveres medical science as natural (“hard”) science and wrongly assumes that a “medical model” of psychiatry must ultimately have biological and/or physiological validity.
I advocate that psychiatry pathologizes “sadness” — social welfare problems of natural emotional suffering from traumatic experiences and other natural “problems in living.” Psychiatry has a long tradition of confusing natural emotional pain with symptoms of pathology (or existential crises). Psychiatry denies our humanity when it advocates that sadness, anxiety, and depression are diseases (or disorders or existential crises) rather than natural expressions of sad experiences, distressful experiences and depressing experiences respectively.
I challenge the “medical model” with a “social welfare model” (free at NaturalPsychology.org); it’s based on true behavioral neuroscience as explained in an article recently published here at the ISEPP homepage (https://psychintegrity.org/behavioral-neuroscience-the-path-forward/).
Regards, Steve Spiegel

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